Risk management in museums of the Czech Republic is inadequate and is not implemented in most museums. The presented issue of risk management in museums is only the first step towards introducing this knowledge into museums. The introduction of risk management as part of an integrated museum management system is essential, as emergencies and disasters are very democratic and unexpectedly affect all nations of the world and, thus, various institutions. Risk management should occur primarily by the application of common sense principles. When preparing a risk management plan, managers should avoid drowning the risk management plan in technical details, actuarial charts, and probability statistics. As a rule of thumb, the simpler the risk management strategy, the more likely it will be implemented. Those responsible for implementing risk management must plan to understand the importance of their activities. The risk management plan will certainly not address all of the institution's risks but will generate new responses to state of the art. Risk management is not a task and a goal but a long-term process.

History reveals an ever-increasing caboodle of protective measures for assuring an acceptable level of safety for both new product designs and for the remediation of man-made and natural hazards. Some seventy years ago, safety professionals began to functionally categorize these safety tools and rank the categories according to their perceived effectiveness. At first, the resulting hierarchies were designated Safety Hierarchies; later updated versions are now referred to as Hierarchies of Controls. To characterize Hierarchies, sixty-six references were surveyed that were published after 1952. Each of these design recipes begin with the admonition “Eliminate the hazards.” All of the hierarchies were created using consensus or speculation, not research. We establish that the Safety Hierarchies and the Hierarchies of Controls are merely rules of thumb, not theorems. Generally, different hierarchies give rise to different designs. The principal strength of both Hierarchies is their replacement of the myth of colloquial safety as “freedom from harm” with a realistic technical definition of safety as an “acceptable level of risk” that is systematically achievable however tortuous.

To report the case of a four year old girl with Tessier 4 right-sided orofacial cleft deformity, type I left cleft foot and hypoplastic right thumb. The patient presented with right-sided congenital orofacial defect, left foot defect and abnormally small right thumb noticed at birth. The pregnancy, labor and delivery periods were uneventful. She subsequently had repair of the orofacial cleft and the cleft foot defects. The post-operative period was uneventful. The patient is currently being followed up in the clinic. Tessier 4 cleft, though a rare orofacial cleft deformity may occasionally be associated with other congenital anomalies as it is found in the index case.

Der Inhalt dieses Songs aus dem Jahre 1966 beschreibt die wechselseitigen Abhängigkeiten und kleinen Grausamkeiten eines jungen Paares. Im gleichen Jahr wurde während einer Live Performance dieses Stücks durch die Rolling Stones im kalifornischen Altamont das gewaltsame Ende der vorher eher beschaulichen Hippie-Ära eingeleitet. Durch den Mord eines Zuschauers durch das „Security-Personal“ der Hells Angels erlangte dieser Song traurige Berühmtheit. Begleitet sein Thema heute als Soundtrack unser neues aktuelles Leben?

Background: De Quervain’s tenosynovitis is an inflammatory disease in which the pain is felt over the radial border of the wrist especially in the thumb with the ulnar deviation of the wrist. The objective of the study was to find out the incidence of De Quervain’s tenosynovitis in regular computer operators. Materials and Methods: Each participating person among the 147 regular computer operators was examined for the Finkelstein’s Test in order to diagnose the De Quervain’s tenosynovitis. Along with this a wrist pain questionnaire was asked to be filled in order to check the prevalence of wrist pain in regular computer operators. Results: Among 147 regular computer operators there were 74 (50.3%) males and 73 (49.7%) females with a mean age of 22.44 ± 1.81 years. Among 147 participating regular computer operators 99 (67.3%) showed the Finkelstein’s test positive whereas 48 (32.7%) showed the pain in Finkelstein’s test as being negative. Conclusion: It is concluded that the incidence of De Quervains Tenosynovitis among the regular computer operators on the basis of Finkelstien Test was quite high.

Objective To investigate the application and clinical efficacy of pulley forceps in the surgical treatment of basal fractures of the first metacarpal bone involving carpometacarpal joint. Methods From June 2014 to December 2018, 14 cases of basal fractures of the first metacarpal bone involving carpometacarpal joint were treated. The space between abductor pollicis longus tendon and extensor pollicis brevis tendon was served as the first operative window. The fracture end and carpometacarpal joint of thumb were exposed. The periosteum was cut on the ulnar side of the extensor pollicis brevis tendon served as the second operative window. C-shaped pulley forceps was placed on the volar and ulnar side of the bone fragments. The bone fragments were hooked and controlled. The first metacarpal bone was pulled and pronated by an assistant. Under direct vision, anatomical reduction of bone fragments can be seen. Kirschner wire with a diameter of 1.0 or 1.2 mm was used to fix the fracture and carpometacarpal joint of thumb at the second and first operation windows respectively. After 4 weeks of plaster fixation, Kirschner wire was removed which was used for fixation of carpometacarpal joint of thumb and brace was used for fixation. The rehabilitation training of each joint of thumb was done intermittently. After 2 to 3 months, the remaining Kirschner wires were removed according to the fracture healing. Results After operation, all the wounds achieved primary healing. The articular surface was anatomically reduced and the fracture position was good. 10 patients were follow-up for 6 to 36 months. According to Gu Yudong evaluation method of opposition function, all the results were rated as excellent. The movement of carpometacarpal joint of thumb was normal in all directions. The VAS score was 0 in 7 cases, 1 in 1 case and 2 in 2 cases. Conclusion In the operation of the basal fractures of the first metacarpal bone involving carpometacarpal joint, C-shaped pulley forceps can reduce the operation difficulty, simplify the operation and improve the operation efficacy, which has a strong promotion significance. Key words: Fracture fixation; Treatment outcome; Pulley forceps; The base of the first metacarpal bone

Objective To explore the clinical effects in repairing dorsal complex tissue defect of finger with the flap based on superficial palmar branch of radial artery (SPBRA) with palmaris longus tendon. Methods From May, 2011 to October, 2017, dorsal complex tissue defects of 15 fingers and thumbs in 15 patients were treated by the flaps which were based on SPBRA with palmaris longus tendon. There were 10 males and 5 females, in an average of 35.8 (19-51) years. All the defects (3 thumbs, 5 index, 2 middle and 5 ring fingers) were dorsal complex tissue defects and all had extensor tendon defects. The areas of soft tissue defect measured 2.0 cm×1.5 cm to 4.0 cm×2.0 cm. The lengths of tendon defect measured 2.0-4.0 cm. All patients received emergency surgery. The time before the surgery was 1.5-3.0 hours. The surgery time was 3.0-4.5 hours, 3.6 hours in an average. Postoperative regular follow-up. Results All of the wounds healed in stage I and all flaps survived. Texture of the flaps was soft with rosy color. No obvious swelling occurred. All the donor sites healed in stage I. The patients were followed-up for 4-18 months, 8 months in an average. The appearance and function of the repaired fingers and thumbs were satisfactory. The pain, temperature and touch sensations were good. The color of flaps was similar to the normal finger without swelling. The wear resistance of the flaps was good. Thin-line scars were in the wrist donor sites without contracture. The range of motion of active palmar flexion of the wrist was from 0° to 80° and active hyperextension was from 0° to 70°. No obvious limitation was found. Conclusion It is able to achieve a satisfactory clinical effects by using the flap that is based on SPBRA with palmaris longus tendon in repairing the dorsal complex tissue defect of hand. The advantages of the technique are that the donor site is concealed. The wound is small, and the flap is easy to be harvested and anastomosed. Key words: Superficial palmar branch of radial artery flaps; Complex tissue flaps; Palmaris longus tendons; Finger; Repair

By the pricking of my thumbs

Objective To investigate the clinical efficacy of the first dorsal metacarpal reverse fasciocutaneous flap with the superficial branch of radial nerve for repair of thumb defect. Methods From January 2013 to June 2017, 14 patients with thumb defect were treated using the first dorsal metacarpal reverse fasciocutaneous flap with the superficial branch of radial nerve. The flap area was 2.0 cm×1.5 cm to 4.5 cm×3.5 cm. The donor area was sutured directly in 11 cases and covered with full thickness skin graft in 3 cases. Results All the 14 flaps were survived uneventfully without vascular crisis, necrosis and infection. The patients were follow-up for 6 to 15 months. The appearance of the fingers was aesthetic, the texture was soft, the skin color was close to the surrounding tissue, and the skin flap had good wear resistance. After the operation, the sensation of the flap recovered to S3+ with the two-point discrimination being 6 to 9 mm. The sensation of pain and temperature were recovered. Patients can use their thumbs for daily work and life. Conclusion The first dorsal metacarpal reverse fasciocutaneous flap with the superficial branch of radial nerve has the advantages of reasonable flap design, reliable blood supply, convenient cutting and simple operation. It is an ideal operation for repairing thumb defect. Key words: Surgical flaps; Treatment outcome; Thumb defect; Superficial branch of radial nerve

Award-winning thumb and finger guard

Background: To evaluate long-term esthetic, functional, and sensory outcome and preferability of distal digit replantations with respect to contralateral intact finger. Materials and Methods: A total of 63 single-or multi-digit clean cut amputations distal to distal interphalangeal joint (DIPJ) involving nail fold in 45 consecutive patients (mean 29 years, 26 males, 19 females) who underwent replantation surgery between 2010 and 2016 were included in this study. Esthetic outcome, functional, and sensory outcome were assessed in the postoperative 6 months, 1 year, and 3 years. Results: Single-digit amputation was noted in 34 patients including thumb (n = 9), index finger (n = 10), middle finger (n = 7), ring finger (n = 7), and little finger (n = 1). Multi-digit amputations were evident in 11 patients involving 2 fingers in five patients (index + middle in two patients, middle + ring in two patients, and thumb + index in one patient), 3 fingers in five patients (index + middle + ring in 4 patients and middle + ring + little in one patient), and 4 fingers in one patient (index + middle + ring + little). All patients were operated within the first 4 h of hospital admission. Postoperative 3-year outcome was excellent in 79.3% of operations, good in 14.2%, and acceptable in 6.3% of operations. None of the operations resulted in poor or very poor outcome and none of the patients had functional loss during the entire follow-up period. A very satisfactory sensory outcome with static two-point discrimination test findings of

This paper presents a convolutional neural network-based classification of the hand flexion and extension gestures used in wrist recovery after injury. The hand gesture recognition device used in our study is the Leap Motion controller. The Leap Motion device's inability to accurately differentiate the left hand from the right hand when performing hand rotation gestures was eliminated by introducing hand and thumb direction vectors into the database used to train the neural network. A 3D environment was created for the introduction of the data describing the gesture into the database. A classification accuracy of 95% was achieved for the hand flexion and extension gesture divided into three levels for each hand. The populated database may also be used to classify other gestures involving hand rotation.

Objective To introduce the method for reconstruction of thumb defect by transplanting free flap of second toe combined with the hallucis flap. Methods From June, 2012 to February, 2017, a total of 9 cases of thumb defect were treated. The average age of these 9 patients was 26 years. The plane of thumb defect was class II area A to class III area A. According to the condition of thumb defect, designed the incision on the hallux and the second toe of the contralateral foot, and cut the 2nd digit and big-toe nail flap with a common arterial trunk. The nail of hallucis flap was rotated 90 degree and connected to the distal end of the 2nd toe. The hallucis flap covered the narrow neck of the 2nd toe. Thus, the circumference of the reconstructed finger and the length of the toenail were increased. Regular followed-up was made after operation. Results All 9 transplantation flaps survived, and donor sites healed primarily. Postoperative followed-up period ranged from 4 to 12 (averge,7) months. All the reconstructed thumbs survived and donor toes were in satisfactory appearances. According to the Functional Assessment Criteria of the Upper Limb Formulated by the Hand Surgery Society of Chinese Medical Association, the outcomes were graded as excellent in 6 cases and good in 3 cases. All the patients were able to manage their daily activities independently. Donor toe injury was small, and their shape and function was good. Conclusion Free flap of second toe combined with hallucis can effectively improve the appearance of the reconstructed thumb. The appearance of the reconstructed thumb is symmetrical, beautiful, and the function is good. Key words: Thumb reconstruction; Second toe; Hallucis flap; Tissue transplantation; Thumb defect

Objective To observe the location and the distribution of distal 1/3 segment of the second dorsal metacarpal artery, the finger web artery and the dorsal digital artery, and to provide anatomical data for repairing the soft tissue defect on the hand with bilobed or multi-lobed micro-flap with second metacarpal dorsal artery-dorsal digital artery. Methods From June, 2018 to March, 2019, 34 fresh adult upper limb specimens were selected. The radial and ulnar arteries were perfused with red latex in 24 specimens. The radial and ulnar arteries were infused with cast materials to make cast specimens in 10 specimens. The location and distribution of the distal 1/3 segment of the second dorsal metacarpal artery, the finger web and the dorsal digital artery were observed. Results The distal 1/3 segment of second dorsal metacarpal artery extended (4±1) cutaneous branches, and continued to become the finger web artery at the plane of the articular surface. The length of the finger web artery was (2.5±0.6) cm, and there were 4 types anastomic methods of communication with arteries. The second dorsal metacarpal artery extended 2 finger dorsal artery to the proximal dorsal skin of the middle finger and index finger. The length of dorsal digital artery was 2.6±0.4 cm and the diameter was 0.2±0.1 mm. Four to 6 micro-cutaneous branches were extended and consistent with the nearby skin cutaneous branches. Conclusion The distal segment of the second dorsal metacarpal artery and the dorsal digital artery is anatomically constant. The distal segment of the second dorsal metacarpal artery and dorsal digital artery are the pedicle for the design of the bilobed flap of middle finger and index finger to repair small soft tissue defect on the thumb and purlicue. Key words: Second dorsal metacarpal artery; Finger web artery; Dorsal digital artery; Bilobed flap; Applied anatomy

Objective To introduce a modified method of thumb reconstruction by combined transplantation of free big toe nail bone flap and second toe tibial flap. Methods According to the condition of thumb defect, free big toe nail bone flap and second toe tibial flap with the common vascular pedicle were cut from the first and second toes of the ipsilateral foot. The second toe tibial flaps were transversely transferred to the tibial side of the toe nail bone flap to reconstruct the toe nail flap belly and nail folds, improve the shape of the reconstructed thumb and reduce the damage of the donor site. Results All the 7 cases survived and the donor and recipient wounds achieved primary healing. The postoperative follow-up period ranged from 3 to 15 months. The reconstructed thumb had good appearance and normal function. According to the functional evaluation criteria of the upper limb issued by the Hand Surgery Society of Chinese Medical Association, the results were graded as excellent in 5 cases and good in 2 cases. All the patients could manage their activities of daily living independently. The donor site had little injury, good shape and function. Conclusion The method of reconstructing thumb defect with free big toe nail bone flap combined with second toe tibial flap can effectively improve the appearance of reconstructed thumb, make the reconstructed thumb symmetrical, beautiful and functional, and reduce the damage of donor toes. Key words: Thumb; Surgical flaps; Second toe; Reconstruction

Objective To compare the effect of arthrodesis and arthroplasty in patients with thumb carpometacarpal osteoarthritis, and to compare the advantages and disadvantages of the two methods. Methods From February 2012 to September 2017, 39 patients with phases Ⅱ and Ⅲ thumb carpometacarpal osteoarthritis underwent surgical treatment. 22 cases were performed with trapeziometacarpal arthrodesis and 17 cases were performed with trapezial excision arthroplasty with ligament reconstruction and tendon interposition (LRTI). Postoperatively, objective and subjective evaluation were performed on the two groups, respectively. The objective evaluation included grip strength, pinch strength, thumb abduction degree (palmer and radial), Kapandji opposition score. The subjective evaluation included visual analogue scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) score. The data of the two methods were compared and their differences were observed. Results In the comparison between arthrodesis and arthroplasty group, the differences of pinch strength, thumb abduction degree (palmer and radial), Kapandji opposition score were obvious, but there was no significant difference in grip strength, VAS and DASH score. Conclusion For patients with progressive thumb carpometacarpal osteoarthritis, carpometacarpal arthroplasty or arthroplasty can significantly relieve joint pain and improve grip strength. Arthrodesis can improve thumb pinch strength better, while arthroplasty can improve thumb mobility better. The patients are consciously satisfied with the effects of the two surgical methods. Key words: Thumb; Carpometacarpal joints; Arthrodesis; Arthroplasty

Objective To report the clinical application and efficacy of three kinds of anastomosis methods of digital artery in replantation of degloving amputated thumb and fingers in children. Methods From May 2012 to July 2018, 16 children with 17 fingers of degloving amputated injuries were replanted. According to Hou Ruixing's classification method of finger degloving injury type Ⅲ, the cases were classified intoⅠ degree of 6 fingers,Ⅱ degree of 11 fingers base on different skin avulsion planes. Three kinds of anastomosis methods of digital artery were in situ anastomosis of bilateral digital artery in 7 cases 8 fingers, cross anastomosis of a digital artery in 7 cases 7 fingers and transposition anastomosis of adjacent digital artery in 2 cases 2 fingers. Results The replantation of 17 fingers in 16 cases was successfully completed. The postoperative blood circulation was good. Among them, 7 cases 8 fingers with bilateral digital artery anastomosis survived, 3 cases 3 fingers with cross anastomosis of a digital artery occurred necrosis, and 2 cases 2 fingers with transposition anastomosis of digital artery survived. Thirteen patients with 14 fingers survived were follow-up for 3 to 36 months, with an average of 18 months. The growth of nails was found in all the fingers anastomosed with bilateral phalangeal arteries, including 2 cases of nail growth deformity, 1 case of partial absorption of the distal phalangeal bone leading to the shortening of the distal phalangeal body, while the function of pinching and the skin color and temperature were normal. The growth of nails was found in 4 surviving affected fingers with cross anastomosis of a digital artery, including 2 cases of nail growth deformity, 2 cases of partial absorption of the distal phalangeal bone leading to the shortening of the distal phalangeal body, which did not affect the holding function with slightly poor skin color, low temperature and finger body atrophy. The growth of nails was found in all the fingers with transposition anastomosis of digital artery, including 1 case of nail growth deformity. The finger was shorter and thicker than the healthy side. The flexion and extension of the finger were good. The skin color was normal and the skin temperature was slightly lower. According to the functional evaluation criteria of replantation of severed fingers issued by Hand Surgery Society of Chinese Medical Association, the results were rated as excellent in 7 cases, good in 4 cases and poor in 2 cases. Conclusion For Urbaniak Ⅲ type amputated finger, replantation should be performed as long as the finger body is relatively intact, and the blood supply should be reconstructed by in situ anastomosis of bilateral digital arteries as far as possible. This method has high survival rate and good recovery of finger shape and function after replantation. Key words: Replantation; Treatment outcome; Child; Degloving injury

Objective To explore the surgical method and clinical efficacy of emergency finger reconstruction with forearm replantation using abandoned fingers. Methods From February 2003 to February 2019, 15 patients with only 2 or 3 finger intact were treated by forearm replantation using abandoned fingers for finger reconstruction. Among them, 3 fingers were reconstructed in 2 cases and 2 fingers were reconstructed in 13 cases. Results All reconstructed fingers survived and the wounds achieved primary healing. The follow-up time was 3 to 12 months with an average of 6 months. The reconstructed finger was similar to the original finger in shape, with good function, grasping and other basic functions. The pulp sensation recovered well. The two-point discrimination was 5 to 10 mm. The patients were satisfied. According to the evaluation criteria of thumb and finger reconstruction function issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 3 cases, good in 9 cases and fair in 3 cases. Conclusion Emergency replantation of forearm with abandoned fingers to reconstruct finger is an ideal method for emergency treatment of wrist injury, reconstruction and recovery of some hand functions. Key words: Finger injuries; Replantation; Microsurgery; Hand reconstruction

Thumb War

What a crooked thumb taught me.